Pregnancy-Induced and Chronic Hypertension

Question 1

What is the difference between pregnancy-induced hypertension and chronic hypertension?

Answer 1

1. PIH - BP >140/90 after 20/40 without proteinuria

2. CH - BP >140/90 before 20/40

Question 2

What should be done in pregnancy-induced hypertension to rule out pre-eclamptic toxaemia?

Answer 2

Protein:creatinine ratio

Question 3

What is the treatment in pregnancy-induced hypertension if >150/100?

Answer 3

Start labetalol and test urine and BP twice weekly

Question 4

What is the treatment in pregnancy-induced hypertension if >160/110?

Answer 4

Admit to hospital and test BP 4x daily, and blood and urine daily.

Question 5

When is the aimed delivery for pregnancy-induced hypertension?

Answer 5

> 37/40

Question 6

How should medical management of chronic hypertension be changed preconception?

Answer 6

1. Stop ACEi, ARB, thiazides

2. Switch to labetalol 1st line or nifedipine 2nd line

Question 7

How is chronic hypertension managed throughout pregnancy?

Answer 7

1. Aim BP <150/90, admit if >160/110
2. Aspirin 75mg per day
3. Foetal USS from 28/40 every 4 weeks for growth
4. Uterine artery doppler for PET
5. Induction of labour at due date
6. Oxytocin and not syntometrine in 3rd stage of labour
7. Monitor BP postnatally